Understanding the prevalence of pharmacies and lab capacity to accelerate test and treat opportunities, improves the entire health care enterprise.
By David Pope, PharmD, CDE
Pharmacies, chiefly purveyors of prescriptions and over-the-counter medications, have evolved, as have hospital outpatient 340B-type pharmacies. In increasing numbers, pharmacies are buying physician practices. Meanwhile, hospital pharmacies are buying retail pharmacies to extend their reach as a place of care for the broader community.
Because of provider shortages and healthcare deserts, there is an increased demand for clinical services at pharmacies, and therefore labs can look at pharmacies as an area of opportunity, since pharmacies performing clinical services will need laboratory support.
Meanwhile, healthcare expenses have soared and continue to rise exponentially, surging past inflation, which had been flat until recently. In just the last two decades, the price of TVs, mobile phones, toys, and computer software have dropped 40 to 80%, while health care costs have risen more than 200%.[i]
In addition to rising costs impacting the state of health care, the issues of missed clinical visits and first-fill drop offs (when prescriptions are filled but not picked up) have become worse in recent years. Due to the COVID pandemic, there has been a gap of nearly 1 billion missed clinical visits.[ii] While there has been a rebound in clinical visits since 2020, there is still a net decline in visits of 10% below pre-COVID-19 levels.[iii] Diagnostics have bounced back to a 5% decline[iv] below their pre-pandemic levels. Prescription fills, however, have not rebounded, and remain nearly 20% below[v] pre-COVID pharmacy fill levels.
How These Pain Points Hurt Patients & Health Care
When health care is not easily accessible and chronic conditions go undetected or are not properly managed, patients often present with more advanced disease stages than they would have otherwise. For example, people with cancer may show up with metastatic cancer, or those with diabetes may end up with end-organ damage.
This highlights the urgent need for collaboration between laboratories and pharmacies to enhance patient care in the evolving healthcare ecosystem. By joining forces, labs and pharmacies can unlock three key benefits that can not only improve patient care and outcomes but also contribute to revenue stream growth.
- Partnerships between pharmacies and labs help rural & underserved communities
Today, while 20% of the[vi] U.S. population lives in rural communities, only 11%[vii] of physicians practice in such areas. That means that the patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas[viii].
However, it is easier than ever for patients to seek basic care and treatment, with convenient care options readily available via pharmacies. Right now, almost 90% of Americans live within five miles of a pharmacy and 73% live within two miles.[ix]
Pharmacist-provided care is also what people want. An opinion poll of seniors conducted last year found that 80%“want local pharmacy access to vaccines, testing and treatments for flu, strep or future pandemic infections”; and an even greater number (85%) said that they want Congress to ensure older Americans have access to a broader array of pharmacy services, including testing, vaccination, etc. for infectious diseases like flu, strep and RSV.”
According to a J.D. Power survey,[x] 51% of Americans visited the pharmacy to get a health and wellness service, such as vaccines or routine screening, and COVID testing. Is it any wonder that pharmacies are seeing their patients 10 times more than physicians or other health care providers?
In 2023, we are now at the crossroads of pharmacy and diagnostics, as pharmacists are in the process of innovating and looking to expand through “test and treat” and “screen and treat.”
Across the country, pharmacists are testing for pharmacogenomics (California), cholesterol (Ohio), colon cancer (Kentucky), and even infectious diseases, like HIV nationwide. Genetic testing, while standard for labs, is in great demand for targeted treatments pertaining to all major cancers and new areas like thalassemia and obesity, as well next-generation sequencing and pharmacogenomics. Beyond providing insight on the compatibility of medicines based on a patient’s DNA and associated metabolism by drug type, a test that says that you have X, Y, or Z can also ensure the right dosage for greater clinical effectiveness based on the patient’s genomic profile.
Prior authorization policies from payors can require routine rapid tests, such as INR liver function and CBC, as well as low acuity type tests, which cannot be provided without the help of labs.
- Financial opportunities for growth for both pharmacy and lab
Today, pharmacists across the country, operating at the intersection of diagnostics and treatment, will book office hours. Put another way, pharmacists are a “new” provider in town. Pharmacists can now order and prescribe in certain states. Currently, 37 states allow direct access to testing. Nearly 40 states recognize pharmacists as providers, thanks to the Public Readiness and Emergency Preparedness Act (PREP Act), which was established in 2005 and reaffirmed in 2020 to allow pharmacists to prescribe oral medication to COVID patients.
Retail, specialty, and outpatient pharmacies can all benefit from a stronger relationship with labs and in so doing, help each other financially. Helping to drive revenue are specialty oncology and immunotherapy medications, which account for 55%of all pharmacy sales, nearly doubling from 28% in 2011.[xi] Auto-immune medications grew by 459% and oncology was up 346% in that same period.[xii] But auto-immune therapies require special considerations because they cost hundreds of thousands of dollars.
Specialty pharmacies need help to gather lab test results pre- and post-dispensing. Among the specialty drugs requiring lab tests are:
- Hep C, which requires checking the viral loads
- HIV PrEP and PEP, which can be prescribed after testing
- Clozepine, which cannot be dispensed until verification of white blood cell count
For the relationship to work best, laboratory, specialized diagnostics, and pharmacy leaders must understand:
- The real-world impact of diagnostics on patient treatment decisions are critical for advancing personalized medicine initiatives.
- The opportunity for greater patient convenience and affordability as some services shift away from the physician’s office to the pharmacy.
- Changing regulatory trends enable pharmacists to perform more clinical services to help ensure better treatment utilization, coverage, and patient/provider experience.
As payors demand more testing data for service, the great digital ecosystem is able to funnel more patients into the four walls of pharmacies, creating a greater need for lab services.
- Opportunity to align in advocacy to support patients at the point of care.
Pharmacies and labs must align on advocacy, particularly key legislation introduced across the country including in the U.S. House and Senate in Washington, DC, to the State Assembly in California.
It is time for policymakers, in Washington and in state capitols across the country, to formally institutionalize the temporary measures taken during the recent public health emergency (PHE) to make essential pharmacist care and services fully accessible and easily affordable, especially for our most vulnerable and underserved communities.
In this ever-evolving health care landscape, pharmacies and labs have the opportunity to be change agents and contribute to better healthcare services for patients across America. Working together, pharmacies and labs can answer the call to align and back legislation that supports pharmacists as providers, help patients across the U.S. gain greater access to affordable care, and reap the benefits of improved health outcomes while growing business revenue.
About the Author
David Pope, PharmD, CDE, is Chief Pharmacy Officer at XiFin, driving the company’s innovation and product portfolio strategy for pharmacy. He is a nationally recognized expert in medical informatics and clinical services in the pharmacy space and has served as an advisor for the Centers for Disease Control and Prevention (CDC) as well as multiple Fortune 500 health-care-related organizations.
[i] Perry, Mark J. “Chart of the Day….or Century?,” January 11, 2019, https://www.aei.org/carpe-diem/chart-of-the-day-or-century/#:~:text=During%20the%20most%20recent%2021,average%20hourly%20earnings%20(wages).
[ii] Law, Hannah, “Understanding the U.S. Return,” June 18, 2021, https://www.iqvia.com/locations/united-states/blogs/2021/06/understanding-the-us-return#:~:text=One%20of%20the%20more%20remarkable,’t%20(Exhibit%202).
[iii] Law, Hannah, “Understanding the U.S. Return,” June 18, 2021, https://www.iqvia.com/locations/united-states/blogs/2021/06/understanding-the-us-return#:~:text=One%20of%20the%20more%20remarkable,’t%20(Exhibit%202).
[iv] Law, Hannah, “Understanding the U.S. Return,” June 18, 2021, https://www.iqvia.com/locations/united-states/blogs/2021/06/understanding-the-us-return#:~:text=One%20of%20the%20more%20remarkable,’t%20(Exhibit%202).
[v] Law, Hannah, “Understanding the U.S. Return,” June 18, 2021, https://www.iqvia.com/locations/united-states/blogs/2021/06/understanding-the-us-return#:~:text=One%20of%20the%20more%20remarkable,’t%20(Exhibit%202).
[vi] Jaret, Peter, “Attracting the next generation of physicians to rural medicine,” February 3, 2020, https://www.aamc.org/news/attracting-next-generation-physicians-rural-medicine
[vii] Jaret, Peter, “Attracting the next generation of physicians to rural medicine,” February 3, 2020, https://www.aamc.org/news/attracting-next-generation-physicians-rural-medicine
[viii] “About Rural Health,” September 1, 2023, https://www.ruralhealth.us/about-nrha/about-rural-health-care#:~:text=The%20patient%2Dto%2D%20primary%20care,the%20health%20of%20the%20population.
[ix] Berenbrok, Lucas A., Tang, Shangbin, Gabriel, Nio, Patel, Nimish, Dickson, Sean, Hernandez, Immaculada, “Access to community pharmacies: A nationwide geographic information systems cross-sectional analysis,” July 12, 2022, https://www.japha.org/article/S1544-3191(22)00233-3/fulltext#:~:text=Findings&text=Using%20geographic%20information%20systems%20analysis,exists%20across%20the%20United%20States
[x]“Retail Health and Wellness Services Surge in Popularity, Driving Significant Gains in Pharmacy Customer Satisfaction, J.D. Power Finds,” July 28, 2021, https://www.jdpower.com/business/press-releases/2021-us-pharmacy-study
[xi] “The Use of Medicines in the U.S. 2022,” April 21,2022, https://www.iqvia.com/insights/the-iqvia-institute/reports/the-use-of-medicines-in-the-us-2022
[xii] “The Use of Medicines in the U.S. 2022,” April 21,2022, https://www.iqvia.com/insights/the-iqvia-institute/reports/the-use-of-medicines-in-the-us-2022